This chapter discusses the case of a 72-year-old man who presented with fresh rectal bleeding. Past medical history included a myocardial infarct 12 years previously and controlled hypertension. Colonoscopy demonstrated a 1.5 cm polypoid sigmoid tumor not amenable to colonoscopic removal, and biopsies showed invasive adenocarcinoma. He proceeded to laparoscopic high anterior resection and, other than a superficial wound infection at the umbilicus, he made a good postoperative recovery. Histopathology demonstrated an early polyp cancer. Pathological examination showed no evidence of malignancy in the resected specimen and no additional therapy was recommended by the multidisciplinary team (MDT). The patient's recovery was complicated by an anastomotic leak and a prevertebral collection, too small for radiological drainage. Local recurrence after a high anterior resection for a T1 tumor would have been unusual and it is still uncertain whether this was the case, or whether the chemoradiotherapy sterilized it.